Application For Employment

Transcription

1 Application For Employment DuPage Water Commission 600 East Butterfield Road Elmhurst, Illinois It is the policy of the DuPage Water Commission to provide equal employment opportunities to all employees and applicants for employment and to abide by all applicable federal, state, and local equal employment opportunity laws. All employment decisions, including, but not limited to, recruitment, hiring, placement, training, promotion, and compensation, for all job classifications will be made without regard to race, color, religion, sex, national origin, ancestry, age, marital status, sexual orientation, citizenship status, veteran status, disability or handicap, or any other legally protected category, except as required or allowed by job necessity, preemptive statutes or other laws. (PLEASE PRINT IN YOUR OWN HANDWRITING, IN INK. DISABLED APPLICANTS MAY REQUEST ACCOMMODATION, IF NECESSARY.) Date of Application Position(s) Applied For Referral Source: Advertisement Friend Relative Walk-In Employment Agency Other Name LAST FIRST MIDDLE NUMBER STREET CITY STATE ZIP CODE Telephone: AREA CODE If employed and you are under 18, can you furnish a work permit? Have you filed an application here before? If, give date Have you ever been employed here before? If, give date Are you employed now? May we contact your present employer? Have you ever been discharged or asked to resign from employment with any employer? If yes, state details, including the name and address of each such employer and the reasons given for the discharge or requested resignation: AN EQUAL OPPORTUNITY EMPLOYER

2 Are you a United States citizen or do you have the legal right to be employed in the United States? (Proof of legal authorization to work in the U.S. will be required if hired.) On what date would you be available for work? Are you available to work Full Time Part-Time Shift Work Temporary Can you travel overnight if a job requires it? Have you been convicted of, or plead guilty to, a felony? (A conviction or guilty plea will not necessarily disqualify you from employment. Factors such as the number of violations, the length of time that has elapsed since the conviction(s)/plea(s), the seriousness and nature of the violation(s), the circumstances of the offense(s) and rehabilitation will be considered.) te: Do not include criminal history record information ordered expunged, sealed, or impounded under the Illinois Crime Identification Act. If yes, provide details, including the nature, date and location of the crime(s), and the disposition of the case, including any prison term or other sentence imposed. If the position for which you are applying requires operation of a motor vehicle, do you have a valid drivers license? List professional, trade, business or civic activities, memberships, and offices held that you believe are relevant to the position for which you are applying (You may exclude those which indicate race, color, religion, sex, national origin, sexual orientation, age, ancestry, disability or other protected class status). Give name, address and telephone number of three references who are not related to you and are not previous employers. -2-

3 Employment/Military Experience List all employment, including military service, beginning with your current or last position. Please account for all time, even if you are providing a resume. 1 Employer Telephone 2 Employer Telephone 3 Employer Telephone 4 Employer Telephone If you need additional space, please continue on a separate sheet of paper. Special Skills and Qualifications Summarize the special skills and qualifications that are relevant to the position for which you are applying that you acquired from your previous employment or other life experiences. -3-

4 Education Elementary High School College/University Graduate/ Professional School Name Years Completed: (Circle) Diploma/Degree Describe Course Of Study: Describe Specialized Training, Apprenticeship, Skills, and Extra-Curricular Activities that are relevant to the position for which you are applying. Honors Received: State any additional information you feel may be helpful to us in considering your application. Have any of your former employment, education, military service, or criminal convictions been under a name other than the one listed at the beginning of this application (for example, an alias, assumed name, or nickname)? If yes, please list all other names. Applicant's Statement I certify that all of the information in this application and any other application materials (and accompanying resume, if any) is true, complete and correct to the best of my knowledge. I understand and agree that any incorrect statement, falsification, material misrepresentation, or omission of any information in connection with this application, resume, and/or other application materials, whenever or -4-

5 however discovered, may disqualify me from further consideration for employment or, if I am hired, may result in disciplinary action, including immediate dismissal from employment. I authorize a thorough investigation of me, my past employment, background, criminal history, education and activities. I understand that this investigation may include a fingerprint check. I agree to cooperate in such an investigation, and release and discharge from all liability, responsibilities, claims or damages of any kind or nature all persons or entities requesting or supplying information pursuant to such investigation, including the Commission, any reference from whom information is obtained, and any third party which provides information used for employment purposes. If I am hired, I further authorize the Commission to supply my employment record, in whole or in part, without prior notice, to any prospective employer, government agency, or other party with a legal or proper interest. I understand that, if I am given an offer of employment, my employment will be conditioned upon me taking and passing a medical and physical examination, which will include a drug and alcohol test. I also understand that if I am hired, during the course of my employment, I may be subject to drug or alcohol testing. I agree to submit to any such lawful test. I understand that my refusal to submit to such lawful test and/or receipt of a positive test result may disqualify me from further consideration for employment or, if I am hired, may result in disciplinary action, including immediate dismissal from employment. Furthermore, I understand that my signature below serves as my consent to a drug or alcohol test and authorizes the release of the results of said test to the DuPage Water Commission for appropriate review. I understand and agree that, if I am hired, my employment will be on an at-will basis, which means that either I or the Commission can terminate the employment relationship at any time, for any reason, with or without cause, and with or without notice. I further understand that, if I am hired, I will not be employed for any specified time, and that this application is not, and is not intended to be, a contract for employment or continued employment, and that no personnel recruiter, interviewer, or any other representative of the Commission other than the General Manager has any authority to enter into any agreement or contract for employment for any specified duration or period of time, and then, only in writing. I understand that if I am hired, as a condition of employment, I must produce certain documentation to verify my identity and U.S. citizenship status or, if I am an alien, my legal authorization to work in the United States. As a consequence, I understand that any offer of employment I may receive will be contingent on my ability to produce the required documentation within the time period required by law. If I am hired, I understand that I will be required to abide by and conform to the rules and regulations of the Commission that govern my employment. I understand that my violation of such rules and regulations may result in disciplinary action, including immediate dismissal from employment, as determined in the Commission's discretion. I understand that under the Commission's policy, this application will remain active for only 90 days. Therefore, if I have not been hired within 90 days of the date of this application and I still wish to be considered for employment with the Commission, I understand that I will need to complete and submit a new employment application. I certify that I have read and understand the foregoing paragraphs. I understand that this is simply an application for employment and does not imply that I will be employed. Signature of Applicant Date -5-

6 Arrange Interview For Personnel Department Use Only Employed Date of Employment Hourly Rate/ Salary Department By NAME AND TITLE DATE -6-